B-cell Pseudolymphoma Research Articles

Hist-PO-01 - Comparative analysis of the clinical, histopathological and molecular genetic features of 29 cases comprising cutaneous B-cell lymphomas and B-cell pseudolymphomas in Singapore

Hist-PO-01 - Comparative analysis of the clinical, histopathological and molecular genetic features of 29 cases comprising cutaneous B-cell lymphomas and B-cell pseudolymphomas in Singapore

Analysis of clonality in cutaneous B-cell lymphoma and B-cell pseudolymphoma using skin flow cytometry: Comparison of immunophenotyping and gene rearrangement studies.

To identify clonal neoplastic cells in skin affected by B-cell lymphoma using skin flow cytometry (FCM) techniques, we investigated light-chain restriction using skin FCM with clonality assessed by polymerase chain reaction and light-chain restriction by in situ hybridization (ISH). We retrospectively analyzed 16 cases of B-cell lymphoma with cutaneous involvement: primary cutaneous diffuse large B-cell lymphoma, leg type (pcDLBCL-LT) (n=7), DLBCL-not otherwise specified (DLBCL-NOS) (n=6), primary cutaneous follicle center lymphoma (pcFCL) (n=1), and follicular lymphoma (n=2), as well as cutaneous B-cell pseudolymphoma (n=9). Results of skin FCM light-chain restriction analyses were compared with immunoglobulin H (IgH) gene rearrangement and κ/λ ISH findings. Skin FCM detected light-chain restriction in 11 of 14 B-cell lymphoma patients but none of the B-cell pseudolymphoma patients. The sensitivity of skin FCM for distinguishing B-cell lymphoma and B-cell pseudolymphoma was 79%, and the specificity was 100%. Eleven of 13 B-cell lymphoma patients exhibited gene rearrangement (sensitivity 85%), whereas six of seven pseudolymphoma patients were negative (specificity 86%). ISH was positive in three of 16 B-cell lymphoma cases (sensitivity 19%) but none of the B-cell pseudolymphoma cases (specificity 100%). ISH sensitivity was 29% for pcDLBCL-LT, 17% for DLBCL-NOS, and 0% for pcFCL and follicular lymphoma. Skin FCM therefore appears to be more sensitive than ISH in detecting light-chain restriction in DLBCL and follicular lymphoma, and as sensitive as IgH gene rearrangement analysis in detecting clonality. Skin FCM is thus a promising diagnostic tool for identifying monoclonal neoplastic B-cell populations.

Cutaneous B-Cell Pseudolymphoma Successfully Treated with Triamcinolone Acetonide

BACKGROUND: Cutaneous pseudolymphoma (PSL) is a reactive polyclonal benign lymphoproliferative process in the skin that simulate cutaneous lymphomas clinically, histologically, or both, predominantly composed of either B-cells or T-cells, localized or disseminated. PSL clinically manifests as solitary nodules or plaque on the face. In cases where cutaneous PSL is suspected, the most crucial part is diagnosis, to differentiate benign or malignant lesion. Diagnosis required a combination of clinical, histopathological, and immunohistochemistry examination. CASE REPORT: A 59-year-old man presented with asymptomatic erythematous plaque on her cheek for 6 months before. Histopathological examination revealed dense small lymphocytic infiltration forming lymphoid follicles with centrum germinativum that partially destructed skin appendice glands. Immunohistochemistry examination showed positive result on cluster of differentiation (CD)20 and CD3 staining. With domination of CD20 treatment: Patient was treated with intralesional injection of triamcinolone acetonide 10 mg/ml and showed satisfying result after 3 times injection. CONCLUSION: A cutaneous B-cell PSL in a 59-year-old man was diagnosed based on history and physical, histopathological, and also immunohistochemistry examination. Intralesional injection of 10 mg/ml triamcinolone acetonide gave satisfying result.

Cutaneous B-Cell Pseudolymphoma (Lymphocytoma Cutis) of the Earlobe: A Poorly Recognized Complication of Ear Piercing in Children

Background: Cutaneous pseudolymphoma (CPL) refers to a group of benign, reactive processes that mimic cutaneous lymphoma and are associated with a variety of triggering immune stimuli, including arthropod bites, drugs, and foreign bodies. In children, most cases of CPL are due to a variant of Borreliosis that is specific to Eurasia. Cutaneous pseudolymphoma secondary to ear piercing has only been documented in adults. Case Reports: We present the clinical and pathological findings of cutaneous Bcell psuedolymphoma in two adolescent patients (11-year-old female and 15-year-old male) secondary to ear piercing. Conclusion: Our report expands the clinico-pathological spectrum of CPL associated with ear piercing by documenting its occurrence in children.

Successful treatment of cutaneous B-cell pseudolymphoma with photodynamic therapy

Successful treatment of cutaneous B-cell pseudolymphoma with photodynamic therapy

Treatment of Cutaneous Lymphoid Hyperplasia with Rituximab: A Case Report of 3 Patients

Benign Cutaneous Lymphoid Hyperplasia (CLH) is a B-cell pseudolymphoma of an unknown origin. The face is the most affected site in CLH. This report presents the cases of 3 patients with CLH who were treated with rituximab. It is a hypothesis that rituximab is useful for treating resistant-to-relapsing forms of CLH that do not respond to previous therapies but must be checked with appropriate designs research.

Lymphocytoma cutis arising in generalized morphea: A case report

Introduction: Morphea is characterized clinically by indurated skin and fibrosis of the dermis or subcutaneous tissue. Lymphocytoma cutis is a cutaneous B-cell pseudolymphoma that mimics B-cell lymphoma clinically. We report a case of lymphocytoma cutis arising in generalized morphea.

B-cell cutaneous lymphoid hyperplasia: report of two cases and histopathologic differentiation of cutaneous B-cell lymphoma

B-cell cutaneous lymphoid hyperplasia (B-cell pseudolymphoma) represents a heterogeneous group of benign reactivelymphoproliferative diseases caused by polyclonal B-cell rich lymphocytic infiltrates, simulating the appearance of acutaneous B-cell lymphopma clinically and/or histologically. A histopathologic differentiation of cutaneous lymphoidhyperplasia with follicular growth pattern from follicle center cell lymphoma is important. However, the differentiationbetween cutaneous lymphoid hyperplasia and cutaneous lymphoma is somewhat difficult and close long-term follow-upmay be necessary. Herein, we present two cases of B-cell cutaneous lymphoid hyperplasia with a clinico-pathologicreview of the literature.

Phenytoin Induced Cutaneous B Cell Pseudolymphoma.

Cutaneous pseudolymphomas are benign lymphoproliferative processes mimicking lymphomas clinically and histologically. One of the precipitating factors for pseudolymphoma is drugs like anticonvulsants, antidepressants and angiotensin-converting enzyme inhibitors. According to existing literature phenytoin-induced cutaneous pseudolymphomas are usually T-cell predominant. Most often withdrawal of the drug with or without short-course systemic steroids can attain a cure. Rarely malignant transformation has been reported years later despite withdrawal of the offending drug, which necessitates a long-term follow up of the affected. We report an 80-year-old male patient who was receiving phenytoin sodium and who presented with diffuse erythema and infiltrated skin lesions which histologically resembled cutaneous B-cell lymphoma. Substituting phenytoin with levetiracetam achieved resolution of symptoms. Further evaluation was suggestive of a reactive process. A detailed drug history is of paramount importance in differentiating drug-induced pseudolymphoma from lymphoma. Searching literature we could not find any previous reports of phenytoin-induced cutaneous B-cell pseudolymphoma.

Case of immunoglobulin G4‐related skin disease: Possible immunoglobulin G4‐related skin disease cases in cutaneous pseudolymphoma only by immunohistochemical analysis

Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized disease characterized by elevated serum IgG4 levels, tissue infiltration rich in IgG4(+) plasma cells. We report on a case which was first considered as pseudolymphoma from the histopathological analysis, but finally diagnosed as IgG4-related skin lesions. As the morphological features of cutaneous involvement of IgG4-RD are consistent with those of cutaneous pseudolymphoma, we tried immunostaining past potential cases of IgG4-RD. Thirty-two skin specimens (15 men and 17 women; mean age, 53 years) diagnosed as having pseudolymphoma were retrieved from the archives to conduct hematoxylin-eosin, IgG and IgG4 staining. Out of the 32 cases of cutaneous pseudolymphoma, germinal center formation was seen in 22 cases, and moderate-severe fibrosis was seen in seven cases. Eleven cases showed more than 10 IgG4(+) plasma cell infiltration/high-power field, and among these 11 cases, seven cases (22%) showed A ratio of IgG4(+)/IgG(+) cells of more than 40%. Thus, out of the 32 cases of cutaneous pseudolymphomas, two cases (6.3%) satisfied IgG4-RD histopathological diagnostic criteria. As clinical presentations and histopathological features of skin involvement of IgG4-RD are analogous to cutaneous B-cell pseudolymphoma, careful identification is required through systemic examination, serum IgG4 measurement and other means.

Microvessel Density and Expression of Vascular Endothelial Growth Factor and its Receptors in Different Subtypes of Primary Cutaneous B-cell Lymphoma

A proangiogenic micromilieu is associated with a worse prognosis in systemic lymphoma. Hence, targeting the tumour microenvironment and its vasculature has evolved as a promising novel treatment strategy. The role of tumour neoangiogenesis in cutaneous B-cell lymphoma, however, has not yet been elucidated. Therefore, we examined the expression of vascular endothelial growth factor (VEGF) and its receptors VEGFR-1 and VEGFR-2, as well as microvessel density by immunohistochemistry in paraffin-embedded specimens of different subtypes of primary cutaneous B-cell lymphomas, systemic diffuse large B-cell lymphoma, and cutaneous B-cell pseudolymphoma. Primary cutaneous large B-cell lymphoma (PCLBCL) were characterized by significantly higher intratumoral expression levels of VEGF and its receptors in comparison with the indolent lymphoma subtypes. Moreover, PCLBCL exhibited significantly higher intratumoral microvessel counts. Our study provides evidence that the most aggressive subtype of cutaneous B-cell lymphoma, PCLBCL, is characterized by a proangiogenic micromilieu.

Miliarial‐type perifollicular B‐cell pseudolymphoma (lymphocytoma cutis): a misleading eruption in two women

Disseminated miliarial-type lymphocytoma cutis is a rare clinicopathologic subtype of lymphocytoma, characterized by numerous translucent micropapules and located on the head and neck. We describe here the clinical, histological and immunological features of miliarial-type perifollicular B-cell pseudolymphoma in two women aged 32 and 49 years presenting with numerous 1-2 mm translucent papules on the head and neck. Microscopic examination revealed features typical of a miniature lymphocytoma cutis with a superficial nodular infiltrate housing small well-circumscribed germinal centers containing tingible body macrophages and surrounded by a distinct mantle zone. The immunohistological profile was also typical of lymphocytoma cutis, and polymerase chain reaction analysis of the IgH gene rearrangement did not show any clonal B-cell population. The lesions resolved spontaneously in one case and improved after treatment with hydroxychloroquine in the second patient. The presentation of this subtype of lymphocytoma is a formidable clinical diagnostic challenge. Rosacea, sarcoidosis, democidiosis, lupus miliaris disseminatus faciei and steroid acne are easy to exclude on the basis of histological profile. However, the miliarial form of primary cutaneous center lymphoma is difficult to rule out. Dermatologists and dermatopathologists should be aware of this unusual form of lymphocytoma cutis, which can be misleading during clinical diagnosis.

Zoledronic acid–induced cutaneous B-cell pseudolymphoma

Zoledronic acid–induced cutaneous B-cell pseudolymphoma

MODERN CLASSIFICATION OF CUTANEOUS PSEUDOLYMPHOMAS

SUMMARY Systematizing of different diseases and skin disorders is quite difficult. Different authors make classifications according to numerous criteria. Pseudolymphomas are reactive lymphocytic proliferations that appear in the skin and resemble a malignant lymphoma. Different classifications exist for cutaneous pseudolymphomas. The broadest classification differentiates them into 6 groups, but the most commonly used is the classification based on clinical and morphological criteria. According to the latest classification (1998), they are divided into cutaneous T-cell pseudolymphomas and cutaneous B-cell pseudolymphomas. The evidence from the histopathological analysis is of utmost important for the accurate diagnosis.

Polymerase Chain Reaction-Based Clonality Analysis of Cutaneous B-Cell Lymphoproliferative Processes

INTRODUCTION:The differential diagnosis of B-cell lymphoproliferative processes remains a challenge for pathologists, dermatologists and oncologists, despite advances in histology, immunohistochemistry and molecular biology.OBJECTIVE:Evaluate aid and limitations of clonality analysis in the diagnosis of primary cutaneous B-cell lymphomas and B-cell pseudolymphomas.METHODS:This study included 29 cases of B-cell lymphoproliferative processes classified as primary cutaneous B-cell lymphomas (13), B-cell pseudolymphomas (6) and inconclusive cases (10) using histology and immunohistochemistry. The clonality analysis was performed by polymerase chain reaction analysis of immunoglobulin light chain and heavy chain rearrangements.RESULTS:DNA quality was shown to be generally poor; eight samples were inadequate for polymerase chain reaction analysis. The results showed monoclonality in eight of the primary cutaneous B-cell lymphomas and polyclonality in four of the B-cell pseudolymphomas. In addition, monoclonality was shown in two of the inconclusive cases by histology and immunohistochemistry, demonstrating the utility of polymerase chain reaction as an ancillary diagnostic tool for primary cutaneous B-cell lymphomas.DISCUSSION:The low quality DNA extracted from these cases demanded the use of an IgH protocol that yielded small fragments and IgK. Both methods used together improved detection.CONCLUSION:Use of the two protocols, immunoglobulin heavy chain FR3-trad and immunoglobulin light chain-Kappa Biomed protocols for clonality analysis improved diagnostic accuracy.

A Case of Cutaneous B-cell Pseudolymphoma

A Case of Cutaneous B-cell Pseudolymphoma

CD123-positive Plasmacytoid Dendritic Cells in Primary Cutaneous Marginal Zone B-cell Lymphoma

The histogenesis of primary cutaneous marginal zone B-cell lymphoma (PCMZL) has not yet been clarified. Plasma-cytoid dendritic cells (PDC) play a crucial role in the initiation of immune responses and activation of T-cells and B-cells. We analyzed the presence of PDC by immunohistochemistry in various forms of primary cutaneous B-cell lymphomas and in B-cell pseudolymphomas. Clusters of CD123+PDC were observed in all PCMZL (23 of 23 cases; 100%) and in two-thirds of cutaneous B-cell pseudolymphomas (14 of 22; 64%), but only in a minority of primary cutaneous follicle center lymphoma (4 of 31; 13%) and not in primary cutaneous diffuse large B-cell lymphoma, leg type. CD123+ PDC clusters were found in close proximity to monoclonal plasma cells and T-cells and were already present at high numbers in early lesions and initial recurrences of PCMZL. In conclusion, the detection of larger clusters of PDC in PCMZL provides a useful adjunctive diagnostic marker and suggests a pathogenetically relevant role of these cells in PCMZL. Furthermore, the occurrence of PDC could explain the high number of T-cells typically found in PCMZL. We propose considering PCMZL as a unique and potentially antigen-driven neoplasm with PDC, T-cells, and B-cells as the constitutive tumor components.

Local Reactions to Tick Bites

A retrospective histological and immunohistochemical study has been carried out in 25 cases of tick bites recorded in our Departments. The samples that included an attached tick showed a cement cone anchoring the mouthparts to the skin and a blood-soaked, spongiform appearance of the superficial dermis, with a mild neutrophilic and eosinophilic infiltration. The vessels displayed a loose multilayered endothelial proliferation, with plump endothelia, permeated with erythrocytes. A few of them were severed, allowing copious blood extravasation. The established lesions included the following: erythema chronicum migrans-like cases, foreign body granulomas-sometimes containing remnants of the mouthparts-cutaneous lymphoid hyperplasia, either of the T-cell or the B-cell type, and tick-bite alopecia. In both the T-cell and B-cell pseudolymphomas, several vessels showed concentric endothelial and perithelial proliferation similar to that seen in the acute lesions. In the tick-bite alopecia, a lymphocytic infiltrate attacked the permanent portion of the hair follicles, whose reaction was a noticeable hyperplasia of the fibrous sheaths, although only a minority of the hairs was destroyed. The observed alterations are specific in the acute lesions and in the alopecia, where they directly arise as a result of the interactions between the host's tissues and the antihemostatic, anti-inflammatory, and immunomodulatory chemicals contained in the tick saliva. In the other lesions, the changes seem less characteristic, although the fragments of mouthparts and the special vascular changes provide a clue to their etiology.

Pseudolinfoma B inducido por hidróxido de aluminio tras tratamiento hiposensibilizante

Aluminium hydroxide is used as an adjuvant in vaccines. We describe the case of a patient who presented a persistent adverse local reaction to aluminium hydroxide due to hyposensitization therapy to dust mites. Multiple painful and pruriginous subcutaneous nodules were observed in both arms, along with hypertrichosis at the injection site. Histology revealed a pseudolymphomatous B cell reaction predominantly involving cells that were CD20 positive, did not express bcl-2, and did not display the t(14-18) translocation. The cells also exhibited polyclonal rearrangement of the immunoglobulin heavy chains. X-ray spectral microanalysis revealed deposits of inorganic aluminium in the granular histiocytes among the germinal centers. The patient was diagnosed with cutaneous B-cell pseudolymphoma due to aluminium hydroxide as a result of immunotherapy.

Palpable Archiform Migratory Erythema Preceded by B-cell Pseudolymphoma in a Japanese Man

Sir, Palpable archiform migratory erythema (PAME) is a rare member of the family of T-cell pseudolymphomas occurring preferentially in adult males (1–5). The clinical picture of PAME is distinctive from other pseudolymphomas because infiltrated annular erythema develops into elevated migrating lesions in the trunk as the predilection site. The aetiology of this condition is unknown and the disease runs a chronic course. We report here a case of PAME in which polyclonal populations of T cells proliferated surrounding a preceding B-cell pseudolymphoma.